When the usual tools to treat paediatric cancer don’t work and a child relapses, medical teams must go back to their toolkits to find more aggressive treatment options. For children with relapsed neuroblastoma, a rare form of nerve tissue cancer that is responsible for 10 per cent of cancer-related deaths in children worldwide, the Garron Family MIBG Suite at The Hospital for Sick Children (SickKids) offers the benefits of innovative, targeted therapy closer to home.

Five-year-old Christophe Dugas is the first patient at SickKids to have undergone this targeted radiation therapy, called high-dose metaiodobenzylguanidine or MIBG, in the Garron Family MIBG Suite. He is doing well and is now at home. Three other patients from British Columbia and Ontario have subsequently received treatment in the new facility.

The specialized procedure consists of a radioactive isotope of iodine (I-131) linked to the MIBG molecule, which is administered intravenously. The therapy is an effective way to carry radiation through the bloodstream, delivering a targeted high-dose of radiation directly to neuroblastoma tumours while sparing other tissues that do not express the receptor for MIBG.

Christophe was diagnosed with stage 4 neuroblastoma in April 2013 when he was four years old. The standard treatment was unsuccessful, so his family was left with few options.

“I first learned about MIBG therapy while doing research online. After speaking with the oncologists at IWK Health Centre in Halifax, I learned that this treatment was available at SickKids. It was such a relief to know that we’d be able to stay in Canada,” says Christophe’s mom, Camille Robichaud, who lives in New Brunswick with her family.

Due to the high levels of radiation exposure in MIBG therapy, the patient must stay in a lead-lined room for five to seven days. The MIBG suite is designed to monitor and minimize radiation exposure to staff and family caring for the patient. It encompasses patient and parent spaces, allowing a parent to safely stay near their child for the duration of the treatment. It is also unique in that this MIBG centre has an integrated radio pharmacy – a place where the radioactive therapy can safely be prepared for administration to the patient.

“The treatment went very well. It is not an easy week for the patient and parents, so our dedicated team works closely with the family to ensure they know exactly what to expect. We responded immediately to all their questions and supported them through their MIBG treatment,” says Dr. Sylvain Baruchel, Director of the New Agent and Innovative Therapy Program (NAIT) and Staff Oncologist in Haematology/Oncology at SickKids.

It can be very challenging for an energetic five-year-old to remain in strict isolation, so the care team made sure Christophe had access to a variety of toys and entertainment.

“As a mother, it was tough to not being able to hold my child for seven days,” says Robichaud. “But the resources in the room made a difficult situation a bit more comfortable, with a couch, TV, and a camera on Christophe the entire time. And Christophe was okay; he was entertained by the video games, iPad and stuffed animals. The team was really well prepared. Everything we needed was there.”

Once the radiation in Christophe’s body was reduced to a safe level, he was discharged. Robichaud says her son is happy to be home in New Brunswick, and even kissed the front door when he arrived.

High-dose MIBG therapy is currently only available for children with relapsed neuroblastoma who participate in clinical trials or through a Health Canada special access program.

“Through the generosity of the Garron family, we are now able to offer MIBG therapy to the children of Canada, here in Canada. Prior to the opening of this facility, many Canadian children had to travel to the United States in order to have access to an MIBG facility,” says Dr. Jim Whitlock, Head of Haematology/Oncology at SickKids.

The $5-million facility is part of the $30-million gift made to SickKids by the Garron Family in October 2010, which established the Garron Family Cancer Centre. It is Ontario’s first and only paediatric MIBG centre and one of two in Canada.

Whitlock adds, “Our facility is scaled to meet the needs of children from all of Canada, and will also give these children an opportunity to participate in promising new clinical trials which combine MIBG with other treatment modalities, with the hope of improving on the effectiveness of MIBG when given as a stand-alone therapy. The Garron Family MIBG Suite will help SickKids maintain its position as a world leader in neuroblastoma treatment and research.”